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� � <br /> PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 Cedar St , Everett, �NA 98201 425-257-8810 FAX 425-257-8857 �vw�,v everettwa.org <br /> SITE A�DRESS: j H PROGEPTV T�X N PER�fiIT <br /> �13ZS �Q�S� tZUS,2�'�" 'd� S <br /> LEGA�br nex[on;lruclion� Short P;aUsuh�iJ,s�o1y-�SGAG��. �!>.LIL Lot No'l S (allach copy of long legal descnplicn) <br /> OWNER FA,��. qL,� �C.. �vN�S Phone�[�ma�i Z��C(�j 3- Z�iO'U <br /> l2 o S w �-�L'�' VN4l.l. 1M4�{ <br /> hdOress 5� �T � l oo c��iyisiaieiz�p Ft�GY�tf W� . ��ZO� <br /> APPLICANT:_Owcer Owner'sAgent __Ceniractor _Conlraclor'sAgenl _Tenant�T�:i;�c»cea���iem:ome�e'm:n:oeo.�.nme�•mrv�ninas;sco� <br /> CONTRACTORSEAIT(St. PAC.I�= � C,� S!ate lic �t�� \i OOS 1311 C�ty f3us. Lic. �(�p3-Lla(o 3�t0 <br /> Adtlress S y�yV��, Phone�Emaa <br /> TENANT BUSINESS NA�.7E CONTACT FOR PERMIT J��N L�� <br /> PhoneiE�matl 4.L5 ) 3so-qc,oz <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK _ <br /> Exishng Use of Butltling HEAT SOURC[�. <br /> Proposed Use ef Bwlamg Gas ✓ fiectnc__. O;her_ <br /> Bwlding Iype �Sir.g'e Fam�ly _Duplex_Tcwnheus= _Mutli�Famry _Commerc�ai <br /> Type of oroiect VHev _Atlddion __Remedel ___Repair__T I S�gn_. _Spr�nKier DemoiiUon __ Change ol Use <br /> DESCRIPTION OF WORKladrnrcnaispacep�ov��edonirebac�l � � <br /> P�I �'03-DD <br /> Z4�Q-� 7LAt�J Z - CA/L C�fa24S�. C1�AS� L , <br /> S�Q � c�d� <br /> MECHANICAL PERMIT APPLICATION PLUM8ING PERMIT APPLICATION <br /> Type of Project: �[Ne�,v_Addn _Alleration_Repair Type ol ProjecC _New_Addn _Alteration,Repair <br /> Shmv Ilurnbcr(dl ol lisfures Show Number(q)o/lir(ures <br /> � NC-auhandhngunds 3 I Totlet <br /> j Forced air systems � Bathtub <br /> A j Gas piping Lavatory(wash bas�n) <br /> Waer heater I Shower <br /> Gas fireplace i Kitchen sink& disposal <br /> i i Gas range ( Dishwasher <br /> I Clothes drycr I Clolhes washer <br /> Range hood \ Wa�er heater <br /> � Exhaustlan l � Sink (seriice/bartmopletc) <br /> � Heat pump 'y � E3ackflow preventer <br /> -�' � Unit heater �"" I Urinal <br /> � poiler — Dnnking Founlain <br /> � Relrigera6on ; floordrain <br /> �, Woodstove I Grease Irap � <br /> Ducling � Rootdrains <br /> � Other �^ � Metlical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM j Other <br /> I NumberofNeatls i Other <br /> I�creCy certAy mai I nave iezd antl eiam��neC th�s appP,wuon ar�know I�e sam.c Ie be Ime ard wrrec� Ail piovisiens al lans ana ommances gOrem�n9¢is IyOa olwerk wJl Ee romp6r� <br /> y;�,:pwheln rs eofe r�ei ,rncl T�eg�onlin3olaperm.l�oesnclp�esvmelogrveaut�on�ylovqlalecrcancell�epmmsionolanycl�erslffieorlou�Ilawregb�dlmgmnsVuclion <br /> Tnal t am i n:e� ��e nner ol i�is F'cF=�y lo pertorm��e�rork for w�ic�apphcaiion I;ma0e anG 1 campiy ru��Ihe State Contradots Lav�iB 77 RGW an0 255 200A WAC I <br /> 1 � <br /> (D-20-1� <br /> Own IAulhorized Agent Signaturc Dale (Revaed 3Q013) <br />